Private Health Insurance Decision Reference 2020-0132

• Jurisdiction: Ireland
• Case Outcome: Rejected
• Reference: 2020-0132
• Year: 2020
• Date: 27 April 2020
• Subject Matter: Private Health Insurance
• Conducts Complained Of: Rejection of claim,
• Finantial Sector: Insurance

Decision Ref:

2020-0132

Sector:

Insurance

Product / Service:

Private Health Insurance

Conduct(s) complained of:

Rejection of claim

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

The Complainant, age 68, holds a health insurance policy with the Provider.

The Complainant’s Case

The Complainant contacted the Provider in January 2018 to confirm cover for liposuction

treatment to her lower left leg under general anaesthetic, at a cost of €2,425; however the

Provider declined cover.

The Complainant sets out her complaint, as follows:

“I had surgery before for a vein in my lower leg which after I got very bad infection.

Since them, my leg has swollen around the knee area and groin which is very painful

and preventing me to go walking and doing my daily duties at home. As I live alone,

it is really very upsetting.

[The Provider] have refused me to have surgery which is very unfair just because my

doctor said there is no code, so I am asking you to please help me, as I am not in a

position to pay for surgery myself – that is why I have private health insurance and

now [the Provider] say they are not able to cover me. This is really unfair and is

upsetting me as it is preventing me from doing daily duties and things I want to do

myself and from taking a walk every day”.

In this regard, her Consultant Plastic Surgeon, Mr A. advised the Complainant in his

correspondence dated 25 July 2018, as follows: